Expert Review of Clinical Pharmacology最新文献_第2页

Non-antibiotic therapeutic approaches for antimicrobial resistance: current evidence and future directions. 抗微生物药物耐药性的非抗生素治疗方法：目前的证据和未来的方向。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-10-01 Epub Date: 2026-09-29 DOI: 10.1080/17512433.2026.2739560

Bharath Kumar Ganesan, Archana Mishra, Debasish Hota, Rituparna Maiti

{"title":"Non-antibiotic therapeutic approaches for antimicrobial resistance: current evidence and future directions.","authors":"Bharath Kumar Ganesan, Archana Mishra, Debasish Hota, Rituparna Maiti","doi":"10.1080/17512433.2026.2739560","DOIUrl":"10.1080/17512433.2026.2739560","url":null,"abstract":"Introduction: Antimicrobial resistance (AMR) is a global health challenge that reduces the effectiveness of existing antibiotics, leading to increased morbidity, mortality and healthcare costs worldwide. The lack of development of novel classes of antibiotics has led to an increased interest in non-antibiotic therapeutic approaches that focus on bacterial virulence, host-pathogen interactions, microbial ecology, and resistance mechanisms.Areas covered: This review summarizes the current evidence on non-antibiotic therapeutics including bacteriophages, antimicrobial peptides, anti-virulence agents, monoclonal antibodies, microbiome-based therapies, CRISPR-Cas systems, nanoparticles, photodynamic therapy, repurposed non-antibiotic drugs and combination strategies. We performed a literature search on PubMed, Embase, Scopus, Web of Science, and Google Scholar until May 2026. Though several approaches have demonstrated promising biological activity and favourable safety profiles, clinical evidence remains limited and heterogeneous.Expert opinion: Non-antibiotic therapeutics are vital adjunctive, salvage and precision approaches to the challenge of AMR. However, most strategies are still at an early translational stage with a paucity of high-quality randomized clinical evidence. Barriers include delivery, manufacturing complexity, regulatory uncertainty, cost, and lack of long-term safety data. Further progress will depend on standardization of production, better delivery platforms, well-designed multicentric clinical trials, and incorporation into antimicrobial stewardship and precision medicine frameworks.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"903-919"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Beyond genotype: dynamic metabolic phenotyping for safer clozapine prescribing in Asian populations. 超越基因型：亚洲人群氯氮平处方安全性的动态代谢表型分析。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-10-01 Epub Date: 2026-09-27 DOI: 10.1080/17512433.2026.2739558

Takahiko Nagamine

引用次数: 0

Authors' reply: evidential standards, levels of inference, and shared objectives. 作者的回答是：证据标准、推理水平和共同目标。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-10-01 Epub Date: 2026-09-30 DOI: 10.1080/17512433.2026.2739122

Adrienne Y L Chan, Ian C K Wong, Kenneth K C Man

引用次数: 0

Off-label drug use in children: prevalence, risks, and regulation. 儿童超说明书用药：流行、风险和监管。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-10-01 Epub Date: 2026-10-09 DOI: 10.1080/17512433.2026.2742318

Antje Neubert, Sonja Eberl

{"title":"Off-label drug use in children: prevalence, risks, and regulation.","authors":"Antje Neubert, Sonja Eberl","doi":"10.1080/17512433.2026.2742318","DOIUrl":"10.1080/17512433.2026.2742318","url":null,"abstract":"Introduction: In pediatrics, drugs require specific study in children rather than being prescribed based on data extrapolated from adults. Historically, this requirement was hindered by various challenges, resulting in widespread off-label drug use. The extent of such use has been extensively investigated, and new regulations in the U.S. and Europe came into force.Areas covered: We conducted a narrative review addressing the epidemiology, associated risks, and regulatory implications of off-label drug use. This involved performing a targeted PubMed search and synthesizing relevant review articles and policy guidelines. The included studies, despite being informative, showed substantial heterogeneity, limiting the comparability and interpretability of their findings. Particularly, quantitative evidence regarding associated risks remains scarce. In addition to risks to patients, liability represents an important concern. Although regulatory policies vary between countries, the level of supporting evidence and accepted standards of practice are consistently central considerations.Expert opinion: Future efforts should therefore focus on using available data to inform individual treatment decisions, ensuring this knowledge is accessible to prescribers, and addressing areas where evidence is particularly limited and patient safety is most compromised. Artificial intelligence and modeling may facilitate evidence generation and improve clinical-trial efficiency. Nevertheless, these approaches should complement, not replace, research conducted directly in pediatric patients.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"921-935"},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CYP2C19 genotype-guided P2Y12 inhibitor therapy optimization in patients at high bleeding risk: existing evidence and future directions. CYP2C19基因型引导的P2Y12抑制剂在高危出血患者中的治疗优化：现有证据和未来方向

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-09-20 DOI: 10.1080/17512433.2026.2733754

Ngoc Phuong Mai Le, Angela Su, Kevin A Friede, Craig R Lee

{"title":"CYP2C19 genotype-guided P2Y12 inhibitor therapy optimization in patients at high bleeding risk: existing evidence and future directions.","authors":"Ngoc Phuong Mai Le, Angela Su, Kevin A Friede, Craig R Lee","doi":"10.1080/17512433.2026.2733754","DOIUrl":"10.1080/17512433.2026.2733754","url":null,"abstract":"Introduction: Use of CYP2C19 genotype to optimize oral P2Y12 inhibitor therapy can reduce major adverse cardiovascular events (MACE) after percutaneous intervention (PCI) in acute coronary syndrome (ACS) patients. Interest in guided strategies to reduce bleeding risk by 'de-escalation' of antiplatelet therapy, particularly in high bleeding risk (HBR) patients, has increased.Areas covered: This review (1) discusses existing antiplatelet therapy de-escalation strategies to reduce bleeding risk in ACS patients, (2) evaluates the representation of HBR patients and bleeding outcomes in clinical trials and real-world studies evaluating CYP2C19 genotype-guided approaches to optimize P2Y12 inhibitor therapy, and (3) identifies knowledge gaps and future research directions to determine the clinical utility of this strategy in real-world settings. A literature search was performed across PubMed, Embase, and Google Scholar (inception-April 2026).Expert opinion: CYP2C19 genotype-guided P2Y12 inhibitor de-escalation can reduce bleeding risk without increasing MACE risk post-PCI. However, this strategy's clinical utility in HBR patients, who may derive the greatest benefit, has not been well-studied. Future research evaluating the impact of genotype-guided de-escalation strategies on post-PCI clinical outcomes in HBR patients is needed. Integrating clinical decision‑support tools, real-world evidence, and multidisciplinary approaches offer potential to optimize P2Y12 inhibitor therapy and improve outcomes in HBR patients.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"807-824"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The emerging role of PDE4 inhibitors for the treatment of pulmonary fibrosis. PDE4抑制剂在肺纤维化治疗中的新作用

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-09-28 DOI: 10.1080/17512433.2026.2737175

Albina Tyker, Naoyuki Kuse, Barak Pertzov, Martin Rj Kolb

{"title":"The emerging role of PDE4 inhibitors for the treatment of pulmonary fibrosis.","authors":"Albina Tyker, Naoyuki Kuse, Barak Pertzov, Martin Rj Kolb","doi":"10.1080/17512433.2026.2737175","DOIUrl":"10.1080/17512433.2026.2737175","url":null,"abstract":"Introduction: Nerandomilast, a phosphodiesterase-4B (PDE4B) preferential inhibitor, was approved in 2025 for the treatment of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). PDE4 enzymes play a central role in regulating intracellular cyclic adenosine monophosphate (cAMP) and are highly expressed in the lung. Through modulation of cAMP, PDE4 inhibition exerts pleiotropic effects on transforming growth factor-β (TGF-β)-dependent and independent signaling pathways, influencing numerous inflammatory and profibrotic processes involved in aberrant wound healing and fibrogenesis. These effects extend across immune cells, macrophages, alveolar epithelial cells, fibroblasts, and the pulmonary vasculature.Areas covered: This review discusses the molecular mechanisms by which the PDE4/cAMP axis regulates pulmonary fibrosis and summarizes preclinical and clinical evidence supporting the development of nerandomilast.Expert opinion: The pivotal FIBRONEER-IPF and FIBRONEER-ILD trials demonstrated significant reductions in the rate of FVC decline in patients with IPF and PPF, including those receiving background nintedanib therapy, establishing PDE4B inhibition as a new therapeutic strategy for pulmonary fibrosis. Beyond its demonstrated efficacy, nerandomilast represents a major therapeutic advance because of its favorable tolerability compared with earlier PDE4 inhibitors and antifibrotics. As clinical experience with nerandomilast expands, real world data will be essential to better define its efficacy, tolerability, safety, and optimal clinical use.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"825-836"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of medications for managing urinary incontinence in people living with cognitive impairment, dementia, or in long-term care: a systematic review. 认知障碍、痴呆或长期护理患者尿失禁药物治疗的有效性和安全性：一项系统综述

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-09-09 DOI: 10.1080/17512433.2026.2729008

Anne Nileshni Fernando, Joan Ostaszkiewicz, J Simon Bell, Cindy Bakhoya Mbingi, Thi Khanh Vy Nguyen, Hanna Thi Ngoc Hanh Pham, Quinn Benedikt Tennent, Emily Jane Trinh, Amanda J Cross

{"title":"Efficacy and safety of medications for managing urinary incontinence in people living with cognitive impairment, dementia, or in long-term care: a systematic review.","authors":"Anne Nileshni Fernando, Joan Ostaszkiewicz, J Simon Bell, Cindy Bakhoya Mbingi, Thi Khanh Vy Nguyen, Hanna Thi Ngoc Hanh Pham, Quinn Benedikt Tennent, Emily Jane Trinh, Amanda J Cross","doi":"10.1080/17512433.2026.2729008","DOIUrl":"10.1080/17512433.2026.2729008","url":null,"abstract":"Introduction: The absence of guidance on pharmacological management of urinary incontinence (UI) for individuals with dementia may lead to potentially avoidable medication-related harm. This systematic review aimed to evaluate efficacy and safety of medications for managing UI in people living with cognitive impairment, dementia, or in long-term care.Methods: Four bibliometric databases were searched for randomized control trials (RCTs) from inception to March 2026. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. Efficacy, adverse events (ADEs), and cognitive effects were synthesized.Results: Nine RCTs (N = 310 participants) were included (all had possible risk of bias). Efficacy of oral anticholinergics ranged from no significant effects to 17% greater reduction in UI symptoms compared with placebo, while oral estrogen demonstrated no significant effects compared with placebo. Dry mouth was the most common ADE for oral anticholinergics (n = 61/194 participants in intervention vs. 26/194 in control across 4 trials). Oral anticholinergic effects on cognition (reported in three trials) ranged from no significant effects to statistically significant short-term declines in attention/alertness compared with placebo.Conclusions: UI medications for people with cognitive impairment or dementia should be prescribed cautiously, with consideration of possible benefits and harms.Prospero: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270946.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"855-870"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Modifying the course and altering the natural history of Crohn's disease. 克罗恩病进入疾病改良时代。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-10-05 DOI: 10.1080/17512433.2026.2737182

Beatriz Gros, Lauranne A A P Derikx, Marie Truyens, Nathan Grellier, Joseph Sleiman, Piotr Eder, Konstantinos Karmiris, Ignacio Catalan-Serra, Sang Hyoung Park, Mohammed Nabil Quraishi, Brigida Barberio, Nurulamin M Noor

{"title":"Modifying the course and altering the natural history of Crohn's disease.","authors":"Beatriz Gros, Lauranne A A P Derikx, Marie Truyens, Nathan Grellier, Joseph Sleiman, Piotr Eder, Konstantinos Karmiris, Ignacio Catalan-Serra, Sang Hyoung Park, Mohammed Nabil Quraishi, Brigida Barberio, Nurulamin M Noor","doi":"10.1080/17512433.2026.2737182","DOIUrl":"10.1080/17512433.2026.2737182","url":null,"abstract":"Introduction: Crohn's disease (CD) can follow a progressive course leading to structural bowel damage and disability. The expansion of advanced therapies and recognition of a window of opportunity have shifted management from symptom control toward disease modification.Areas covered: After searching MEDLINE and Embase from inception until 1 July 2027, we reviewed studies examining early intervention and disease modification in Crohn's disease. This review examines evidence for early medical and surgical intervention as individual treatment strategies to modify the course of disease, distinguishes short-term inflammatory control from durable alteration of disease course, and considers emerging strategies that target fibromuscular remodeling. We also address the heterogeneity of CD, the aspirations for precision approaches, and the challenges of implementing timely, personalized care.Expert opinion: Early intervention and disease modification have evolved over time in Crohn's disease and that there is now a robust evidence-base to support the potential for disease modification in Crohn's disease, particularly with initiation of early effective intervention as soon as possible after diagnosis. Given the successes of early intervention, there is now increasing focus on the potential for preclinical intervention as a means to potentially prevent disease onset, reduce cumulative bowel damage, and avoid long-term disability.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"781-793"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Could tumor necrosis factor inhibitor therapy reduce the incidence of depression among patients with ankylosing spondylitis? 肿瘤坏死因子抑制剂治疗能降低强直性脊柱炎患者抑郁的发生率吗？

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-09-15 DOI: 10.1080/17512433.2026.2733760

Oh Chan Kwon

引用次数: 0

An expert's guide to Acanthamoeba keratitis pharmacology. 棘阿米巴角膜炎药理学专家指南。

IF 3.6 3区医学

Expert Review of Clinical Pharmacology Pub Date : 2026-09-01 Epub Date: 2026-08-28 DOI: 10.1080/17512433.2026.2724060

Rubén L Rodríguez-Expósito, Ines Sifaoui, María Reyes-Batlle, José E Piñero, Jacob Lorenzo-Morales

{"title":"An expert's guide to Acanthamoeba keratitis pharmacology.","authors":"Rubén L Rodríguez-Expósito, Ines Sifaoui, María Reyes-Batlle, José E Piñero, Jacob Lorenzo-Morales","doi":"10.1080/17512433.2026.2724060","DOIUrl":"10.1080/17512433.2026.2724060","url":null,"abstract":"Introduction: Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection, increasingly associated with contact lens wear, whose treatment remains constrained by the lack of agents that are both cysticidal and well tolerated by the cornea. This review appraises the current pharmacological landscape and the obstacles impeding therapeutic progress.Areas covered: PubMed, Scopus, Google Scholar, and Web of Science were searched for articles published between January 2000 and June 2026 using combinations of the terms 'Acanthamoeba keratitis,' 'treatment,' 'pharmacology,' 'amoebicidal' and individual drug names; reference lists were hand-searched. We provide an overview of the epidemiology, biology, life cycle and pathogenic mechanisms of AK. We then critically evaluate current clinical management strategies and their inherent limitations before providing a comprehensive synthesis of recent in vitro and in vivo investigations to identify effective drugs that target both the cyst and trophozoite stages with low cytotoxicity.Expert opinion: Prolonged, intensive topical regimens impose a substantial burden that drives poor adherence and relapse, and standardized protocol-based dosing offers the most immediate practical gain. The field now requires agents combining potent cysticidal activity with corneal biocompatibility, alongside standardized assays and validated ex vivo models, so that promising laboratory activity translates into genuine clinical benefit.","PeriodicalId":12207,"journal":{"name":"Expert Review of Clinical Pharmacology","volume":" ","pages":"795-806"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0